The problem is that a lot of the major package managers - at least nodejs npm/yarn, PHP composer, Apache Maven, Gradle - allow code execution of whatever packages were specified as part of the installation or build process.
That means there are an equal lot of very juicy targets for a takeover - just look at the most popular build plugins... and a few minutes are enough to deploy a keepass and browser credential store stealer to a ton of people. Getting local code execution isn't that difficult if you manage to spray your payload over a huge enough area.
Getting access to a target and their MFA device however is vastly more complicated.